Proton Therapy Myth 1

Myth #1: Proton therapy is experimental and investigational. It is a new, untested science.

This is perhaps the most common myth about proton therapy. It happens to be the excuse many health insurers use to deny coverage for proton therapy for prostate cancer. Of course, the real reason behind the denial is that the initial cost for proton therapy is higher than conventional radiation, but they won’t admit that. So they hide behind the pretense that proton therapy is “experimental” and they have a stated policy of not reimbursing for experimental medical procedures.

If the patient accepts this claim and chooses IMRT or some other form of treatment, then the insurance company wins and the patient loses. If patients fight the denial through the appeals process, and do it smartly, they almost always win. Some choose not to go through the appeals process because they are anxious about their diagnosis, and want to get treated sooner rather than later. So they accept defeat and choose another option. We call this “denial by delay” and it works well for many insurers.

So, where is truth? Is proton treatment new, experimental, or investigational? The answer is “no” on all counts.

Here are some facts:

Berkeley Radiation Laboratory treated the first patient with protons in 1954.

Harvard University treated its first patients in 1961.

Loma Linda opened the first hospital based proton treatment center in 1990.

84,000 patients have been treated with proton therapy through the end of 2011.

There are 10 operating proton centers in the U.S., 10 more under construction and 9 more in the planning stage.

There are 33 proton centers operational worldwide with dozens more planned.

Proton radiotherapy has been the topic of 3,000 papers since 1954.

Proton therapy was FDA approved for use in the U.S. in 1988—24 years ago.

Medicare and about 180 private insurers consider proton therapy an established technology, and have been reimbursing for proton therapy for more than 20 years.

So, is proton therapy experimental and investigational? Hardly. Proton therapy has been around for almost 60 years; tens of thousands of patients have been treated—mostly prostate cancer patients; it is FDA approved, reimbursed by Medicare and 180 private insurers; and reputable medical centers all over the world have embraced the technology and are building proton centers. This does not sound like a technology that is experimental, investigational, or untested science.

As BOB member, Jim Landry, wrote in his Proton Pals newsletter recently, “When your insurance company says this treatment is experimental you can point out that it was experimental in 1954, show them the picture (on the right) from the Berkeley Radiation Laboratory and then tell them how many patients have been treated, a very high percentage of which were for prostate cancer.”